<%@ page language="java" contentType="text/html; charset=UTF-8" pageEncoding="UTF-8"%>
<%@ page import="com.mc.lp.view.constants.*;"%>
<%@ taglib prefix="c" uri="http://java.sun.com/jsp/jstl/core"%>
<%@ taglib uri="http://www.springframework.org/security/tags" prefix="sec"%>
<%@ taglib prefix="spring" uri="http://www.springframework.org/tags"%>
<div class="row">
	<div class="modal fade" id="mappingModal" tabindex="-1" role="dialog" aria-labelledby="myModalLabel" aria-hidden="true">
		<div class="modal-dialog">
			<div class="modal-content">
				<div class="modal-header">
					<button type="button" class="close" data-dismiss="modal">
						<span aria-hidden="true">&times;</span><span class="sr-only">Close</span>
					</button>
					<h4 class="modal-title" id="myModalLabel">Create New Children Registration</h4>
				</div>

				<div class="modal-body">
					
				</div>
			</div>
		</div>
	</div>
	<div class="col-md-12 col-lg-12 col-sm-12">
		<div class="panel panel-default">
			<div class="panel-heading">
				<h3 class="panel-title">Registration</h3>
			</div>
			<div class="panel-body">
				<form role="form" method="post" action="<c:url value="/service/register-user" />">
					<div class="row">
						<div class="col-md-12"><div class="alert alert-success"> <b>Parent Information</b></div></div>
					</div>
					<div class="row sm-font">
						<div class="col-md-6">
							<div class="form-group ">
								<div class="input-group input-padding col-xs-12 col-md-12 col-lg-12 col-sm-12">
									<label for="name">First Name</label> <input type="text" class="form-control" placeholder="First Name" name="firstName">
								</div>
								<div class="input-group input-padding col-xs-12 col-md-12 col-lg-12 col-sm-12">
									<label for="name">Last Name</label> <input type="text" class="form-control" placeholder="Last Name" name="lastName">
								</div>
								<div class="input-group input-padding col-xs-12 col-md-12 col-lg-12 col-sm-12">
									<label for="name">Email</label> <input type="text" class="form-control" placeholder="Email" name="email">
								</div>
								<div class="input-group input-padding col-xs-12 col-md-12 col-lg-12 col-sm-12">
									<label for="name">Mobile No.</label> <input type="text" class="form-control" placeholder="Mobile No." name="mobileNumber">
								</div>
								<div class="input-group input-padding col-xs-12 col-md-12 col-lg-12 col-sm-12">
									<label for="name">Password</label> <input type="password" class="form-control" placeholder="Password" name="password">
								</div>
								<div class="input-group input-padding col-xs-12 col-md-12 col-lg-12 col-sm-12">
									<label for="name">Confirm Password</label> <input type="password" class="form-control" placeholder="Confirm Password">
								</div>

							</div>
						</div>
						<div class="col-md-6">
							<div class="form-group">
								<div class="input-group input-padding col-xs-12 col-md-12 col-lg-12 col-sm-12">
									<label for="name">Address Line 1</label> <input type=text class="form-control" placeholder="Address Line 1">
								</div>

								<div class="input-group input-padding col-xs-12 col-md-12 col-lg-12 col-sm-12">
									<label for="name">Address Line 2</label> <input type="text" class="form-control" placeholder="Address Line 2">
								</div>

								<div class="input-group input-padding col-xs-12 col-md-12 col-lg-12 col-sm-12">
									<label for="name">State</label> <input type="text" class="form-control" placeholder="State">
								</div>

								<div class="input-group input-padding col-xs-12 col-md-12 col-lg-12 col-sm-12">
									<label for="name">City</label> <input type="text" class="form-control" placeholder="City">
								</div>

								<div class="input-group input-padding col-xs-12 col-md-12 col-lg-12 col-sm-12">
									<label for="name">Pincode</label> <input type="text" class="form-control" placeholder="Pincode">
								</div>

								<div class="input-group input-padding col-xs-12 col-md-12 col-lg-12 col-sm-12">
									<label for="name">Country</label> <input type="text" value="India" class="form-control" placeholder="Country">
								</div>
							</div>
						</div>
					</div>
					<div class="row">
						<div class="col-md-12"><div class="alert alert-success"> <b>Children Detail</b></div></div>
					</div>
					<div class="row">
						<div class="col-md-12">
							<table class="table table-responsiv table-hover sm-font">
								<thead>
									<tr>
										<th>SNo.</th>
										<th>Name.</th>
										<th>Registration Number.</th>
										<th>Date.</th>
										<th>Action</th>
									</tr>
								</thead>
								<tbody>
									<tr>
										<td>SNo.</td>
										<td>Name.</td>
										<td>Registration Number.</td>
										<td>Date.</td>
										<td>Action</td>
									</tr>
								</tbody>

							</table>
						</div>
					</div>

					<div class="row">
						<div class="col-md-12">
							<div class="input-group input-padding col-xs-12 col-md-12 col-lg-12 col-sm-12">
								<button type="button" class="btn btn-primary btn-sm">Add Child</button>
							</div>
						</div>
					</div>
					<div class="row">&nbsp;</div>
					<div class="row">
						<div class="col-md-6 col-md-offset-5">
							<div class="input-group input-padding col-xs-12 col-md-12 col-lg-12 col-sm-12">
								<button type="submit" class="btn btn-success">Register</button>
								<button type="submit" class="btn btn-warning">Cancel</button>
							</div>
						</div>
					</div>
				</form>
			</div>
		</div>
	</div>
</div>

